CB3 slides 2

Meet and Greet?

• foam in

• introduce, check pt and allergies

• physical exam, assess how well adapting after childbirth

• wear gloves for body fluid

Next steps?

• begin the assessment with VS

• HR + breath sounds

• IV site

• rapport with pt, provide privacy & expose only body parts that need to be examined

BUBBLE HE

Breasts

Uterus

Bowels

Bladder

Lochia

Episiotomy

Hemorrhoid

Emotional status

What do we look for in a breast assessment?

• inspect reddened area

• cracked/inverted nipple

• bleeding

What actions do we do for a breast assessment

• palpate breasts gently

What does how the breast feel mean?

• soft= colostrum only

• slight firmness= filling with milk

• tightness = engorgement

What teaching would you do for a breastfeeding mom?

• using supportive bra

• handwashing before feeds

• keep nipples dry

• watch for redness/tenderness

What could redness/tenderness mean in a breastfeeding mom?

blocked milk duct —> infection

What would you teach about breasts in a non breastfeeding mom?

• use a supportive bra

• avoid stimulation of breasts

• apply cold packs or cold raw cabbage for cooling

• Lactation suppression will occur (~ day 10)

What assessments would you do for the uterus?

• Inspect c/s for incision for REEDA

• Fundus- firm/boggy?

• palpate top of fundus in relation to umbilicus (U +1, U-1)

• Fundus midline?

• uterus tender to palpitation?

What is REEDA

Redness

Edema

Ecchymosis (bruising)

Drainage

Approximation

If the uterus is off to the side what could that indicate?

A full bladder

What teaching do we provide for uterus?

• Fundal positions- top of uterus should be at or below level of umbilicus (getting lower per day)

• Fundal firmness- a firm fundus = orange/grapefruit underneath

• Massage a boggy uterus = prevent bleeding with one hand at pubic bone, other hand massage pressure below umbilicus in circular motion until uterus becomes firm.

What is the issue with having a boggy uterus?

prone to bleeding

What assessment would we need to do for bowels?

• auscultate bowel sounds prior to palpating abdomen (5-30min norm)

• make sure bowels movement are present after 3 days of birth

How many days does it take for bowel movement to return after birth?

3

What teachings would you give for bowels?

reestablishing normal bowel sounds:

• ambulation

• fluids

• fresh fruits/veggies/fiber

• stool softener

What bladder assessments would you complete?

• assess bladder frequency for distention bc of PP diuresis

• frequency, burning, urgency

• boggy, displaced uterine fundus - sign for bladder distention

If pt is not able to void spontaneously what may we need?

catheterization

What teaching would you give regarding the bladder?

helping to void:

• get pt out of bed frequently

• pour warm water on perineum

• run water in the sink

• increase fluid intake

lochia, what to assess, colors?

asses for color, amount and clots

color: rubra, serosa and alba

Why may clots and heavy bleeding occur in lochia?

uterine relaxation, retaining placental fragments or unknown cervical laceration

What teaching would you provide about lochia?

• tell pt what colors to expect (rubra > serosa > alba)

• after long bed rest - blood may pool in vagina and pt may feel sudden gush of bleeding when standing

• use peri bottle with warm water to cleanse area and change pads after every trip to bathroo

What to inspect when it comes to episiotomy/perineum?

REEDA

What to teach when it comes to episiotomy?

• sutures will dissolve on its own

• ice pack, sitz bath- relief, help

• peri bottles to cleanse after urine/stool

• kegel exercise

• topical spray/foam for pain

What are hemorrhoids?

• inflamed/swollen veins that can protrude from anus, cause mld bleeding, itching, discomfort

• note size, number, tenderness

• teach patient about care/comfort measures

Homans sign

• postpartum women - increased risk for thrombophlebitis

• Pt stretches legs with knees flexes, nurse grabs foot and dorsiflexes it = pain = blood clot